DAY HOSPICE

A “day hospice” provides a very useful half-way stage of support for the terminally ill patient. It often enables an ill patient, who might otherwise need admission to an in-patient facility, to stay at home. It provides rest and relief for family carers. It is particularly helpful for the isolated, the anxious and the house-bound. Medical and nursing involvement is important, because patients have advanced disease and problems can occur suddenly, but the principal goal of the day hospice is social support and recreation.

Good liaison with the family physician, home care nurses and other members of the caring team is important. They should be encouraged to visit the day hospice.

Most day hospices are open for part of the day, once or several times each week. If a free-standing in-patient hospice exists, it should be the site of the day hospice, as familiarity with the building and staff helps to overcome fears of admission for terminal care. (In-patients may participate in day hospice activities, and home care patients attending the day hospice can visit friends now admitted to the in-patient unit.)

If no in-patient facility exists, the day hospice can use any easily accessible community facility, such as a senior citizens’ center, a church, a hospital lounge, etc. (Medical and nursing input remains important.)

Day hospice is a useful way of introducing a patient to the hospice team.

Ideally, a patient is driven back and forth between home and the day hospice by the same volunteer each time, so that a useful “one-to-one” friendship can develop.

Sometimes family members wish to attend the day hospice with the patient, and they should be allowed to do so. However, a common function of a day hospice is to give a couple space from each other (sometimes important even in the most loving relationship). Illness and dependency can bring unaccustomed and excessive closeness, and a few hours apart can often restore normality.

Day hospices can offer:

• Social contact and mental stimulation

• Relief for caring family members

• Psychological support

• Basic nursing care (change dressings, catheters)

• Access to a doctor for symptom control

• Bathing facilities

• Hairdressing and barber facilities

• Physical therapy (mobilization, breathing, relaxation)

• Occupational therapy

• Group recreational activities

• Hobbies and handicrafts

• Family support

• Spiritual support (chaplain, church services)

• Access to a social worker

Discussion – The aim of the day hospice is to help the patient remain as independent as possible. Personal development is encouraged as part of holistic rehabilitation. The emphasis is social and recreational, rather than medical or narrowly therapeutic. Patients (and the occasional family member who wishes to attend) enjoy day hospice activities. (see Occupational Therapy)

Day hospice care can give physical and psychological relief to caring family members, plus “time off”. It can function as an effective support group for patients to discuss their feelings and frustrations.

A day hospice program facilitates discharge of in-patients who after symptom control and rehabilitation are well enough to return home, but can benefit from added support. (see Rehabilitation)

Mr. N. J., an extremely anxious man of 56 with lung cancer, was admitted to an in-patient hospice for pain control, but was too frightened to go home. (“What will I think about all day?”) He started attending the day hospice while still an in-patient, and learned woodworking which he found totally absorbing. This gave him the confidence to get home and continue his hobby there. Returning to the day hospice twice a week, he remained at home for the last 6 weeks of his life. It was a fulfilling time for Mr. N. J. and his wife.

The author and publisher have taken precautions to ensure that the information in this book is error-free. However, readers must be guided by their own personal and professional standards of good practice in evaluating and applying recommendations made herein. The contents of this book represent the views and experience of the author, and not necessarily those of the publisher.